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Interrater reliability and concurrent validity of 4AT for the detection of postoperative delirium: A prospective cohort study Abstract. Background: Numerous tools for detecting postoperative delirium are available. Guidelines recommend the 4 A's Test (4AT). However, there is little evidence on the validity and reliability of the German version of 4AT. Aim: To assess the interrater reliability of the German version of 4AT test for the detection of postoperative delirium in general surgical and orthopedic-traumatological patients, and the concurrent validity with the Delirium Observation Screening Scale (DOS). Methods: The present work is part of a prospective cohort study with a sample of 202 inpatients (≥ 65 years) who underwent surgery. The interrater reliability of the 4AT (intraclass coefficients) was determined with a subsample of 33 subjects who were rated by two nurses. Concurrent validity between the DOS scale and the 4AT was calculated using Pearson's correlation coefficient. Results: Interrater reliability for the 4AT total score and dichotomized total score were 0.92 (95% CI 0.84-0.96) and 0.98 (95% CI 0.95-0.98), respectively. The correlation between DOS and 4AT (Pearson) was 0.54 (p < 0.001). Conclusions: The 4A test can be used by nurses as a screening instrument for the detection of postoperative delirium in older patients on general surgery and orthopedic traumatology wards. In case of positive 4AT results further assessment by nurse experts or physicians is required.

German nursing study programs from the students' perspective: First results of a nationwide longitudinal study Abstract. Background: The Nursing Professions Act establishes a concrete framework for academic nursing education in Germany for the first time. The primary qualifying nursing courses started in 2020 and will be accompanied by a systematic reporting of students' experiences over a period of three years. Aims: The article presents the results of the initial survey period (2021) on the students' point of view. Challenges and the need for further regulation of the primary qualifying nursing studies are analyzed and approaches to solutions are developed. Methods: The online survey is designed as a longitudinal cohort study with three measurement periods (2021, 2022, 2023). A descriptive analysis considers data of N = 57 students in the initial survey period. Results: The primary qualifying nursing study program is rated good overall (overall grade 2.32). However, one third (35.85%) are more critical in their assessments. Every second student perceives a need for adjustment in the financing of students. Learning in clinical placement settings often does not meet students' expectations. 86% of respondents report that nursing practice sites are insufficiently informed about students' qualification. Conclusions: Students' financing, and in particular the payment of assignments in the nursing practice, represents a regulatory gap with need for short-term solutions. For learning in nursing practice, there is a need for an enhanced practical placement guidance that is better geared to academic nursing education. This is accompanied by the need for a more specific definition of later professional fields and job profiles.

Social participation in nursing homes with Covid-19 protection measures in the second pandemic wave? Linkage of prescriptions and survey Abstract: Background: The implementation of protective measures in nursing homes during the Covid-19 pandemic was accompanied with the loss of social participation opportunities in the first Covid-19 wave; this has been inadequately studied for the second Covid wave. Aim: To evaluate the association of protective measures and social participation restrictions for the second Covid-19 wave to develop recommendations for action. Methods: Mixed-methods online surve y of nursing home managers (n = 873) in the second wave. Binary logistic generalized estimating equations were used to evaluate the likelihood of the elimination of social participation services in nursing homes as a function of legal protections. Open-ended responses about maintaining social participation were content analyzed (n = 1042). Results: More than one in two nursing home managers reported prohibited group events (66,6%), and more than one in three prohibited creative activities (42,3%). Visitation restrictions (85,2%) were common in the second wave. The loss of participation services and the protective measures were significantly associated. Qualitative data showed that, for example, the acquisition of mobile shopping stores were opportunities to counteract the social exclusion of the residents. Discussion: The association between the loss of social participation services with the implementation of protective measures was clearly pronounced. Nursing practitioners should focus on enabling social participation whilst guaranteeing protection against infection best possible.

Advanced Nursing Practice (ANP) in the practice of mental health nursing in Germany: A phenomenological study Abstract. Background: The wide variety and constantly changing selection of offered psychiatric care services, in combination with the demand for high quality nursing practice supports the integration of Advanced Practice Nurses (APN). The literature presents a multifaceted picture of APNs working in psychiatric services. Individually chosen emphasis was especially prevalent in the field of care. Gaps in research persist concerning the clinical scope of responsibility. Aim: How does the ANP phenomenon find expression in German clinical psychiatric practice? Method: The dataset comprises problem-focused interviews with three expert APNs from different hospitals. The interviews took place between April and October 2019. Applied phenomenology was used to analyze and interpret the dataset. Results: Soft skills and clinical leadership are pivotal competencies for APNs to perform efficiently in clinical practice. Profound life and work experience are key factors in terms of impact. Conclusions: To perform efficiently, APNs require professional and methodological knowledge at a master's level, profound soft skills as well as clinical leadership expertise. Higher education and further curricular training are required. Establishing APNs in clinical psychiatric practice depends primarily on the decisions of managers in nursing. The management of nursing needs to adopt new care structures that allow APNs to implement their qualifications in the psychiatric care system.

Implementation of a nurse practitioner role in inpatient surgery: A mixed-methods study in a pre-post design Abstract: Background: The study describes the introduction and testing of a Nurse Practitioner role in acute inpatient surgery in a Swiss hospital over a year. Using a Nurse Practitioner can improve continuity of care, quality of care and patient safety. Aim: The short-term outcome of such a role in the field of inpatient surgery is shown after one year. The target variables included nine measurement criteria. Method: The evaluation was carried out using a mixed-method approach, partly in a pre-post comparison. Quantitatively, the number of patients being looked after, the discharge time, interprofessional cooperation, the duration of stay, disruptions to everyday life and the availability of the discharge documents were recorded. The qualitative recording included the experience of the participants. Results: The results of the evaluation indicate an added value of the new role. Indications can be found in the continuity of care and amenability in medical issues of the participants, as well as in the optimization of patient processes. The legally undefined situation in Switzerland proved to be difficult. Conclusions: The strengths of this role were increasing continuity of care, improving responsiveness in medical issues for patients and caregivers, as well as optimizing patient processes and patient safety. The legal requirements regarding competencies currently make it difficult to use NPs in the inpatient sector.

The use of robotic and technical systems for early mobilization of intensive care patients: A scoping review Abstract: Background: Intensive care patients are often subjected to immobility for too long. However, when they are mobilized early, positive effects on patient outcomes, such as improvement in physical function, can be demonstrated. One of the reasons for rare mobilization is that too less therapeutic equipment is available. Aims: This paper provides an overview of previous research on early robot- or technology-assisted mobilization of intensive care patients. Which robotic and technical aids are used in studies on early mobilization of adult intensive care patients by nurses or physiotherapists? What effect of early mobilization using robotic and technical systems on patient outcomes are reported in the studies? Methods: A systematic literature search was undertaken within the Databases Medline, Web of Science, CINAHL, Cochrane Library, Embase, IEEE Xplore, Scopus and WTI between May and July 2020 and in January 2022. In addition, a marginal search was performed via GoogleScolar and ResearchGate in the first search run. Results: 27 publications were included (9 RCTs, 7 texts and opinions, 3 cross-sectional studies, 2 case-control studies, 2 literature reviews, 2 case reports, 2 quasi-experimental intervention studies). It is evident that electronic bed-mounted exercise bicycles and tilt tables are the most commonly used assistive devices. There is an inconsistent data situation with regard to different patient outcomes. Conclusion: Further research on the use of technical and robotic early mobilization is, particularly in relation to different study populations, needed. Early mobilization robotics is not yet part of standard care.

Care for family carers of people with dementia in municipal communities during the pandemic: A Qualitative Study Abstract: Background: The availability of support services for family carers of persons with dementia in the municipal community shows deficits due to the Corona pandemic and thus entails a change in the support of carers. Research question: The questions arise, what changes in the care of family carers of people with dementia do those affected perceive, how do actors from the municipal community experience the care situation during the pandemic and to what extent do the perceptions of the groups coincide or differ. Method: The database consists of town hall talks and focus groups from 13 municipal communities in Germany. Participants were family carers and actors from the municipal community. For data analysis, a qualitative content analysis was carried out. Result: Negative changes in the care of caregivers can be seen, for example, in the omission of care services or groups of relatives. Above all, actors perceived positive changes, such as advancing digitalization or increased neighborly help. The perception of changes in the care situation differs in several subcategories between carers and actors. Conclusion: Although large gaps in care have been created by the pandemic, emerging challenges also create new ways for support such as digital groups for family carers. In the future, opportunities need to be created to implement already developed interventions in such a way that the target group can make use of them.